Perforated Terminal Ileal Ulceration Secondary to Long-Term Nicorandil Therapy Presenting as Acute Peritonitis: A Case Report

Vollständiger Abstract

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Background: Nicorandil, a potassium-channel activator used as second-line anti-anginal therapy, has been increasingly recognised as a cause of mucosal ulceration affecting the oral cavity, skin, and gastrointestinal tract. Ileal and colonic ulceration with perforation is a rare but serious complication. Case presentation: We describe a 73-year-old man with ischaemic heart disease on long-term nicorandil who presented with abdominal pain, distension, vomiting, and absolute constipation. Computed tomography demonstrated free intraperitoneal gas and mural thickening of distal small bowel loops. At emergency laparotomy, a perforated ulcer of the terminal ileum was identified and oversewn, with biopsy confirming benign ulceration. No alternative cause for the perforation was identified. Conclusion: This case adds to a growing body of evidence linking nicorandil to gastrointestinal ulceration and perforation and highlights the importance of considering drug-induced ulceration in patients presenting with unexplained small bowel pathology while on this medication.